Measuring activity limitations in climbing stairs: development of a hierarchical scale for patients with lower-extremity disorders living at home

L.D. Roorda, M.E. Roebroeck, T.G. van Tilburg, G.J. Lankhorst, L.M. Bouter

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    Abstract

    OBJECTIVE: To develop a hierarchical scale that measures activity limitations in climbing stairs in patients with lower-extremity disorders living at home.

    DESIGN: Cross-sectional study with Mokken scale analysis of 15 dichotomous items.

    SETTING: Outpatient clinics of secondary and tertiary care centers.

    PARTICIPANTS: Patients (N=759; mean age +/- standard deviation, 59.8+/-15.0y; 48% men) living at home, with different lower-extremity disorders: stroke, poliomyelitis, osteoarthritis, amputation, complex regional pain syndrome type I, and diabetic foot problems.

    INTERVENTIONS: Not applicable.

    MAIN OUTCOME MEASURES: (1) Fit of the monotone homogeneity model, indicating whether items can be used for measuring patients; (2) fit of the double monotonicity model, indicating invariant (hierarchical) item ordering; (3) intratest reliability, indicating repeatability of the sum score; and (4) differential item functioning, addressing the validity of comparisons between subgroups of patients.

    RESULTS: There was (1) good fit of the monotone homogeneity model (coefficient H=.50) for all items for all patients, and for subgroups defined by age, gender, and diagnosis; (2) good fit of the double monotonicity model (coefficient H(T)=.58); (3) good intratest reliability (coefficient rho=.90); and (4) no differential item functioning with respect to age and gender, but differential item functioning for 4 items in amputees compared with nonamputees.

    CONCLUSIONS: A hierarchical scale, with excellent scaling characteristics, has been developed for measuring activity limitations in climbing stairs in patients with lower-extremity disorders who live at home. However, measurements should be interpreted with caution when comparisons are made between patients with and without amputation.

    Original languageEnglish
    Pages (from-to)967-971
    Number of pages5
    JournalArchives of Physical Medicine and Rehabilitation
    Volume85
    Issue number6
    DOIs
    Publication statusPublished - Jun 2004

    Keywords

    • Activities of Daily Living
    • Amputees
    • Cross-Sectional Studies
    • Diabetic Foot
    • Disability Evaluation
    • Female
    • Humans
    • Lower Extremity
    • Male
    • Middle Aged
    • Models, Statistical
    • Osteoarthritis
    • Poliomyelitis
    • Stroke
    • Journal Article
    • Research Support, Non-U.S. Gov't

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